Key questions on persistent cough in adults

Professor (Hon.) James Hull, consultant pulmonologist and lead for the chronic cough service at Royal Brompton Hospital in London, answers key questions on persistent cough.

Module summary

Persistent cough is a common but challenging presentation in primary care, with causes ranging from post-viral symptoms and medication effects to asthma, reflux, upper airway disease and serious underlying pathology. This module provides a practical, evidence-based approach to assessing adults with cough lasting more than eight weeks.

Professor James Hull, consultant pulmonologist and lead for the chronic cough service at Royal Brompton Hospital, explains how GPs can use a ‘treatable traits’ model to identify contributors, select appropriate investigations and avoid unhelpful empirical treatment. The module also explores cough hypersensitivity and the role of ACE inhibitors, airway eosinophilia, reflux, rhinosinusitis and laryngeal dysfunction in persistent cough, alongside red flags for lung cancer and other respiratory disease. It highlights commonly overlooked causes, clarifies when imaging and specialist referral are indicated, and offers pragmatic advice for managing patients whose cough persists despite initial treatment.

Learning objectives

This module will enhance GPs’ understanding of chronic cough in adults, including:

• How to consider and evaluate the cause of chronic cough.
• An introduction to the concept of cough hypersensitivity.
• The value of using a ‘treatable traits’ model to assess a patient with chronic cough.
• When and how to undertake investigations for chronic cough.
• Some commonly overlooked issues when assessing chronic cough in primary care.

Author: Professor James Hull is consultant respiratory physician at the Royal Brompton Hospital in London and Honorary Professor at the Institute of Sport, Exercise and Health, University College London

Date published: 16.07.2026